AU2007327150A1 - Screening method using sample adsorption on filter paper - Google Patents

Description

WO 2008/064684 PCT/DK2007/000528 SCREENING METHOD USING SAMPLE ADSORPTION ON FILTER PAPER 5 Field of invention The present invention discloses a diagnostic test and method for mixing blood or another biological fluid or sample with a test compound and spotting the blood on filter paper for subsequent analysis of the effect of the test compound on the blood 10 or fluid sample. General background 15 Blood is a complex mixture composed of plasma and cells (1-3). The plasma can be separated from the cells by centrifugation and other techniques. If the plasma is al lowed to stand it will clot by coagulation and serum may be separated from the blood clot. The coagulation may be inhibited by addition of various anticoagulants, including EDTA, EGTA, heparin, citrate and others. The cells of the blood include 20 dendritic cells, macrophages, monocytes, neutrophils, T lymphocytes, B lympho cytes, natural killer cells, red blood cells and various stem cells including hemopoi etic stem cells. In addition megakaryocyte -derived platelets are present in large numbers. The plasma contains thousands of proteins, in principle any protein of the human proteome (4, 5). Some of the proteins are involved in transport, blood clot 25 ting or immune defence, while others function as signalling molecules between cells of the blood and cells of the tissues, In particular, the activity of the cells of the immune system (dendritic cells, macrophages, T cells, B cells, natural killer cells) is regulated by a complex network of signalling molecules (e.g. interleukins, chemokines, growth factors), tissue antigens and receptors (3, 6-9). The activity and 30 specificity of immune system cells can be investigated and quantitated by several methods and assays. T cells, B cells and other cells can be quantitated by fluores cence-activated cell sorting using antibodies to cell surface marker molecules (10, 11). Specific T cells can be measured by cytotoxicity assays, chromium release as says and cytokine release assays (e.g. ELISPOT) (12-16) and by using various pep 35 tide-major histocompatibility complex (MHC) protein constructs (17, 18). The activ 1 WO 2008/064684 PCT/DK2007/000528 ity of B cells can be measured by determining the levels of specific antibodies re leased from the B cells (19, 20). A major problem in measuring signalling molecules released from blood cells is that 5 of storage and transport in relation to quantitation. Many blood constituents (e.g. cytokines) are labile and short lived, resulting in degradation during incubation, storage and transport. For this reason, comparative analyses and diagnostic tests have to be carried out immediately upon blood collection and incubation in central laboratories. Ideally, all samples to be compared should be analysed consecutively 10 using a calibrated instrument. This is not always practical, e.g. when taking blood samples in remote areas, when doing in vitro and in vivo time-studies or when comparing samples from many dif ferent individuals. One solution to this problem is to freeze samples for transport 15 and storage. This, however, does not guarantee preservation of constituents, re quires large freezing, transport and storage capacity, requires thawing each time an analysis is performed, and is vulnerable with regard to shortage of electric power supply, For this reason, there is a need for reliable methods of blood and biological sample preservation and a need for diagnostic tests employing reliable sample 20 preservation in combination with sample manipulation. The use of filter paper for spotting blood for subsequent analysis is well known, e.g. for analysis of blood samples of newborn babies for inherited metabolic diseases (21). The advantages of this are good preservation of blood constituents, easy trans 25 port and facile long term storage. However, the use of filter paper and similar methods for drying and storing blood samples after incubation with test compounds has not been used or described before, possibly because this has been anticipated to be impossible or impractical. 30 Summary of the invention This invention discloses diagnostic tests and methods for mixing blood or another biological fluid with a test compound and spotting the blood on filter paper for dry 2 WO 2008/064684 PCT/DK2007/000528 ing, preservation and subsequent analysis of the effect of the test compound on the blood at any time hereafter. 5 Detailed disclosure of the invention The present invention discloses a diagnostic test and method comprising mixing blood or another biological fluid sample with a test compound and spotting the blood on filter paper for subsequent analysis of the effect of the test compound on 10 the blood. The biological fluid can be a cerebrospinal fluid, a peritoneal fluid, a cyst fluid, an amniotic fluid, a lavage fluid, a saliva, a cell extract or a tissue extract. The compound is chosen among an amino acid, a peptide, a protein, a carbohydrate, an oligosaccharide, a polysaccharide, a glycoprotein, a lipid, a lipoprotein, a glycosa minoglycan, a hormone, a steroid, a vitamin, a low molecular weight synthetic or 15 natural compound which influences the blood to cause an alteration of its composi tion e.g. a toxin, allergen, autoantigen, bacterial protein or polysaccharide, viral protein, fungal protein or polysaccharide, parasitic protein or polysaccharide, bacte rial lipopolysaccharide or any other compound relevant to diseases. 20 The diagnostic test and method according to the invention analyses the sample for the content of cytokines, chemokines and growth factors and/or neurotransmitters and other polypeptides and proteins eg. CRP, IgG, IgA, IgM, IgD, IgE, specific (i.e. antigen specific) antibodies, transferrin, albumin and/or transthyretin. 25 In the diagnostic test the effect of the test compound is analysed by immunoassay, bioassay, mass spectrometry, HPLC, GC, GC-MS e.g. ELISA assays, FLISA assays, DELFIA assays, Luminex assays, luminescence assays, electrochemiluminescence assays, scintillation proximity assays, radioimmunoassays, MALDI-MS, ESI-MS and ambient-MS (e.g. DESI-MS). 30 This invention also discloses a method of mixing blood or another biological fluid or sample with a test compound and spotting the mixture on filter paper for storage, transport and/or handling before subsequent analysis of the effect of the test com pound on the blood, biological fluid or sample. 35 3 WO 2008/064684 PCT/DK2007/000528 Definitions : Analyte means any compound which can be detected or quantitated by analytic 5 means. By the effect of test compound is understood that it interacts with constituents of the blood or any other biological fluid or sample to cause an alteration in the composi tion of the blood of any kind. 10 Drying means removal of water. Filterpaper means any piece of paper, cloth or other material suitable for collecting, drying and storing blood, 15 PKU paper means paper/filter paper used for screening of blood samples from newborn babies for phenyl ketonuria syndrome. Spotting means the application of a blood sample or any other biological fluid or ex 20 tract or sample to a piece of standardised paper suitable for accurate blood sam pling. The spotting is done by applying a fixed volume of blood to a piece of paper or by applying blood to the paper until a defined area is covered with blood. Subse quently, the paper is allowed to dry completely and either stored immediately at low humidity conditions or transported to a storage place for subsequent analysis. 25 Test compound means any chemical, biological or physical compound or substance which can be mixed with or added to blood or any other biological fluid or sample. Test sample means any formulation or mixture of test compounds. 30 The following abbrevitions are used: BCG means Bacillus Calmette-Guerin BDNF means brain-derived neurotrophic factor 35 BSA means bovine serum albumin 4 WO 2008/064684 PCT/DK2007/000528 CRP means C-reactive protein DBSS means dried blood spot sample EGF means epidermal growth factor ELISA means enzyme-linked immunosorbent assay 5 ELISPOT means enzyme-linket immunospot assay ESI means electrospray ionization FLISA means fluorescence -linked immunosorbent assay GC means gas chromatography G-CSF means granulocyte -colony-stimulating factor 10 GM-CSF means granulocyte-macrophage colony stimulating factor HPLC means high performance liquid chromatography IFN means interferon Ig means immunoglobulin IGF means insulin-like growth factor 15 Il means interleukin LPS means lipopolysaccharide MALDI means matrix-assisted laser desorption/ionization M-CSF means macrophage-colony-stimulating factor MCP means monocyte chemoattractant protein 20 MHC means major histocompatibility complex MIF means macrophage migration inhibitory factor MIP means macrophage inflammatory/inhibitory protein MMP means matrix metallo protease MS means mass spectrometry 25 NT means neurotrophin PBS means phoaphate-buffered saline PCR means polymerase chain reaction PKU means phenyl ketoneuria PPD means purified protein derivative 30 TGF means transforming growth factor TNF means tumor necrosis factor TREM means triggering receptor expressed on myeloid cells VEGF means vascular endothelial growth factor 5 WO 2008/064684 PCT/DK2007/000528 The present invention discloses a diagnostic method where the reaction between a test compound and a blood sample or any other biological fluid or sample is initi ated, allowed to proceed for a certain time and then stopped by spotting and/or dry ing the test sample on a filter paper which is then used subsequent for analysis of 5 the effect of the test compound on the blood, fluid or sample and any of their con stituents, In a preferred embodiment a blood sample (e.g. 10 ml) is drawn from a person using standard anti-coagulation EDTA, heparin or citrate blood containers or glasses. The 10 blood sample is divided in two aliquots and a test compound is added to one aliquot of blood, while the other aliquot is used as a control reference to which only the buffer/solution in which the test compound is dissolved is added. The test com pound may also be added as a solid powder to be dissolved directly in the blood. The blood samples are incubated at ambient room temperature or a defined tem 15 perature (e.g. 5 'C, 20 'C, 37 'C) with or without mixing or agitation At certain time intervals (e.g. 0, 1 min, 2 min, 5 min, 10 min, 20 min, 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, 10 h, 15 h, 20 h, 24 h, 48 h) aliquots are drawn from the blood samples and spotted on filter paper (e.g. PKU paper) and allowed to dry as rapid as possible. After dry ing, the filter paper may be used immediately for analysis or stored for subsequent 20 analysis. In a particular embodiment the filter paper may be transported (e.g. by or dinary mail) over a distance before storage or analysis in a laboratory, Spotting, drying and storage of blood are carried out as follows: Blood is spotted on filter paper with a capillary tube, pipette or similar in one layer and dried at room 25 temperature, e.g. in a well ventilated hood or in an ambient place. For storage, the filter papers may be kept in paper envelopes, plastic bags or similar containers, preferably air tight containers to keep the humidity as low as possible. A storage temperature of -20"C or lower is preferable, but room temperature is also possible as long as the paper is kept dry. However, the storage may take place at ambient 30 temperature or at a temperature below 0 *C (e.g. -20 'C, - 50 'C, -80 'C, -180 *C) provided that the humidity is kept low to avoid deterioration of the samples. Sam ples can be stored for extended periods of time (e.g. months - years). The test compounds may be any compound (e.g. an amino acid, a peptide, a pro 35 tein, a carbohydrate, an oligosaccharide, a polysaccharide, a glycoprotein, a lipid, a 6 WO 2008/064684 PCT/DK2007/000528 lipoprotein, a glycosaminoglycan, a hormone, a steroid, a vitamin, a low molecular weight synthetic or natural compound), which influences blood to cause a measur able alteration of its composition. 5 Particularly useful test compounds are toxins, allergens, autoantigens, bacterial pro teins and polysaccharides, viral proteins, fungal proteins and polysaccharides, para sitic proteins and polysaccharides, bacterial lipopolysaccharides, and any other compound relevant to diseases. Use of these test compounds will lead to important knowledge about how a certain compound affects the cells and the signalling be 10 tween the cells, In one embodiment, the diagnostic test and method is used for determining the ef fect of toxic compounds on blood, eg as part of a toxicological test programme or a preclinical test programme. 15 Analysis of the dried blood samples may be carried out by a number of different techniques (e.g. immunoassay, bioassay, mass spectrometry, HPLC, GC, GC-MS). Preferred methods of analysis are ELISA assays, FLISA assays, DELFIA assays, Lu minex assays, luminescence assays, electrochemiluminescence assays, scintillation 20 proximity assays, radioimmunoassays, MALDI-MS, ESI-MS, PCR. Extraction of DBSS may be carried out by the use of any suitable buffer or solvent, In a preferred embodiment, filter paper disks, e.g. 3.2mm in diameter, are punched out from DBSS or standards on filter paper and placed together in microtiter wells. 25 140pl or 180 pl (for double-or triple-measurements, respectively) extraction buffer, PBS containing "Complete protease inhibitor cocktail with ethylenediamine tetra acetic acid (EDTA)" (Roche, Germany) 1 tablet dissolved per 25 ml assay buffer (PBS containing 0.5% Tween 20 and 1% BSA), are added to each well and the ana lytes are extracted protected from light at room temperature on a plate shaker set at 30 600 rpm for 60 minutes. In one embodiment of the invention, analytes are measured by a Luminex assay as follows: coupling of capture antibodies to carboxylated beads (Luminex corp., Aus tin Texas, US) are performed according to the manufacturer's instruction: 2.5 X 106 35 beads are washed twice with activation buffer (0.1 mol/l sodium phosphate, pH 6,2), 7 WO 2008/064684 PCT/DK2007/000528 re-suspended in 80pl activation buffer and sonicated until a homogenous distribu tion of the beads are observed. 10p of solutions of N-hydroxysulfosuccinimide (sulfo-NHS from Pierce, Rockford US) and 10pl 1-ethyl-3(3-dimethylaminopropyl) carbodiimidhydrochlorid (EDC from Pierce), both diluted in activation buffer to 50 5 mg/ml, are added to stabilize the reaction and activate the beads. After mixing, the beads are incubated for 20 min rotating in the dark at room temperature. The acti vated beads are subsequently washed with coupling buffer (mmol/l 2(N-morpholino ethanesulfonic acid, MES), pH 5.0), added 500pl azide-free solution of capture anti body (100 pg/ml) and incubated rotating for 2 hours or overnight. Azide is removed 10 from antibodies by dialysis (Slide-A-Lyzer@ dialysis cassette, MWCO = 10 000 from Pierce) in 31 PBS overnight at 4' C. After incubation, the beads are washed with washing buffer (PBS containing 0.05% Tween 20) and re-suspended in 75pl block ing/storage buffer (PBS containing 1% Bovine serum albumine (BSA) and 0.05% sodium azide). 15 The beads are counted with a hemocytometer, adjusted to a concentration of 20 X 106 beads/ml with blocking/storage buffer and stored protected from light at 2-8' C. The assay procedure is performed as follows: A filter plate (MultiScreen MABVN 20 1.2pm 96-well, Millipore, Burlington US) are prepared by pre-wetting it with assay buffer (PBS containing 0.5% Tween 20 and 1% BSA). To each well are added 50pl of sample pipetted from the microtiter wells after extraction (100pl divided in dupli cates or 150pl divided in triplicates) and a 50pl suspension of capture-antibody conjugated beads, 1500 beads per analyte in assay buffer containing 1% guinea 25 pig/pig serum (1:1). The capture-antibodies react with their corresponding antigens during 1 hour of incubation and unbound material is removed from the beads by filtering it through the wells using a MultiScreen Vacuum Manifold (Millipore), The beads are washed twice using 200pl washing buffer (PBS containing 0.5% Tween) per well. The now captured antigens are reacted for 1 hour with a mixture (50pI) 30 of biotinylated detection antibodies each diluted 1:1000 in assay buffer. 50p1 of streptavidin-phycoerythrin 20 pg/ml in assay buffer (Molecular Probes, The Nether lands) are added to the wells and the incubation continues for additional 30 min. The beads are finally washed twice with 200pl washing buffer and re-suspended in 8 WO 2008/064684 PCT/DK2007/000528 12 5pl washing buffer. After 15 min of shaking, the samples are analyzed on the Luminex 100TM according to manufacturer's instructions, In a preferred embodiment, the samples are analysed for content of cytokines, 5 chemokines and growth factors (e.g. interleukins such as Il-1, Il-2, 11-3, 11-4, 11-5, 11-6, 11-7, 11-8, 11-9, 11-10, Il-11, 11-12, 11-13, 11-14, 11-15, 11-16, 11-17, 11-18, 11-19, 11-20, 11-21, 11-22, 11-23, 11-24, 11-25, Il-26, IFN, TNF, MCP, MIP, MMP-9, TREM, M-CSF, G-CSF, GM-CSF, chemokines such as CC, CXC, growth factors such as TGFa, TGF@, EGF, VEGF, IGF I, IGF II, insulin, inflammatory mediators such as histamine, pros 10 taglandins, leukotrienes, thromboxanes) and/or neurotransmitters. In another embodiment the samples are analysed for standard and specific clinical parameters such as CRP, IgG, IgA, IgM, IgD, IgE, specific (i.e. antigen specific) an tibodies, transferrin, albumin, transthyretin, etc. 15 In another embodiment the biological fluid to be analysed is a cerebrospinal fluid, a peritoneal fluid, a cyst fluid, an amniotic fluid, a lavage fluid, a saliva, a cell extract or a tissue extract. 20 In still another embodiment the source of cells are cell lines or isolated blood cells, manipulated cells, transgenic cells, transfected cells, or any cell type or altered or manipulated cell type. The invention may be applied to blood and other body fluids and tissue extracts 25 from any species and type of animal (e.g. human, monkey, mouse, rat, cow, dog, horse, cat, bird, fish and any other species) including transgenic animals, In a special embodiment the test compound is immobilised on a solid surface (e.g. filter paper) and then incubated with a blood sample or a biological fluid or extract. 30 After incubation, the filter paper is allowed to dry or the blood is spotted on filter paper and dried. In a particular use of the invention, the volume of blood, biological fluid or extract is adjusted to allow interaction with an immobilised compound or a compound in solu 35 tion for a fixed time while at the same time drying on the filter paper. 9 WO 2008/064684 PCT/DK2007/000528 In one use of the invention a live test person or patient is infused with a test com pound and blood samples are drawn from the person at certain time intervals, spot ted on filter paper, dried and subsequently analysed, 5 The blood samples may be drawn from test individuals using standard needles and equipment and carried out by trained personal. However, the drawing of blood may also be carried out using devices allowing local individual sampling. 10 Examples Example 1. Drawing, incubation, spotting, drying and storage of blood. From a test person 10 ml blood is drawn into an anticoagulant test tube using a ster 15 ile needle and syringe. The blood is divided in aliquots of 1 ml using sterile antico agulant test tubes. From one sample a blood sample is spotted directly on paper un til the marked circle is full (the volume used is approximately 0.2 ml). To the other test tubes samples to be tested are added in predetermined concentrations and the test tubes are allowed to incubate at 37 'C or at ambient temperature for 1 h. Sam 20 ples of 0.2 ml are then spotted from each on filter paper. The blood samples are spotted on filter paper with a capillary tube, pipette or similar in one layer and dried at room temperature, e.g. in a well ventilated hood or in an ambient place. Sampels are then stored at -20 'C or room temperature under low humidity, so that the paper is kept dry. For this purpose, ordinary freezers may be used and the papers may be 25 kept in envelopes or in desiccators. Example 2. Extraction of filter paper and analysis. Two filter paper disks, 3.2mm in diameter, are punched out from DBSS or standards on filter paper and placed together in microtiter wells. 140pl or 180 pl (for double-or 30 triple-measurements, respectively) extraction buffer, PBS containing "Complete protease inhibitor cocktail with ethylenediamine tetra-acetic acid (EDTA)" (Roche, Germany) 1 tablet dissolved per 25 ml assay buffer (PBS containing 0.5% Tween 20 and 1% BSA), are added to each well and the analytes are extracted protected from light at room temperature on a plate shaker set at 600 rpm for 60 minutes, 35 10 WO 2008/064684 PCT/DK2007/000528 Example 3. Luminex assay Coupling of antibodies to beads: Coupling of capture antibodies to carboxylated beads (Luminex corp., Austin Texas, US) are performed according to the manufacturer's instruction: 2.5 X 106 beads are 5 washed twice with activation buffer (0.1 mol/l sodium phosphate, pH 6.2), re suspended in 80pl activation buffer and sonicated until a homogenous distribution of the beads are observed, 10pl of solutions of N-hydroxysulfosuccinimide (sulfo NHS from Pierce, Rockford US) and 10pl 1-ethyl-3(3-dimethylaminopropyl) carbodiimidhydrochlorid (EDC from Pierce), both diluted in activation buffer to 50 10 mg/ml, are added to stabilize the reaction and activate the beads. After mixing, the beads are incubated for 20 min rotating in the dark at room temperature. The acti vated beads are subsequently washed with coupling buffer (mmol/1 2(N-morpholino ethanesulfonic acid, MES), pH 5.0), added 500pl azide-free solution of capture anti body (100 pg/ml) and incubated rotating for 2 hours or overnight. Azide is removed 15 from antibodies by dialysis (Slide-A-Lyzer@ dialysis cassette, MWCO = 10 000 from Pierce) in 3 1 PBS overnight at 40 C. After incubation, the beads are washed with washing buffer (PBS containing 0.05% Tween 20) and re-suspended in 75pl block ing/storage buffer_(PBS containing 1% Bovine serum albumine (BSA) and 0.05% sodium azide). 20 The beads are counted with a hemocytometer, adjusted to a concentration of 20 X 106 beads/ml with blocking/storage buffer and stored protected from light at 2-8' C. Example 4. Assay procedure: A filter plate (MultiScreen MABVN 1.2pm 96-well, Millipore, Burlington US) are 25 prepared by pre-wetting it with assay buffer (PBS containing 0.5% Tween 20 and 1% BSA). To each well are added 50pl of sample pipetted from the microtiter wells after extraction (100pl divided in duplicates or 150ipl divided in triplicates) and a 50pl suspension of capture-antibody-conjugated beads, 1500 beads per analyte in assay buffer containing 1% guinea pig/pig serum (1:1). The capture-antibodies re 30 act with their corresponding antigens during 11/2 hour of incubation and unbound material is removed from the beads by filtering it through the wells using a MultiS creen Vacuum Manifold (Millipore). The beads are washed twice using 200pl wash ing buffer (PBS containing 0,5% Tween) per well. The now captured antigens are reacted for 1 hour with a mixture (50pl) of biotinylated detection antibodies each 11 WO 2008/064684 PCT/DK2007/000528 diluted 1:1000 in assay buffer. 50pl of streptavidin-phycoerythrin 20 pg/ml in assay buffer (Molecular Probes, The Netherlands) are added to the wells and the incuba tion continues for additional 30 min. The beads are finally washed twice with 200pl washing buffer and re-suspended in 125pl washing buffer. After 15 min of shaking, 5 the samples are analyzed on the Luminex 100TM according to manufacturer's in structions. Example 5. Test of Gc globulin, diphtheria toxoid, tetanus toxoid and lipopolysac 10 charide (LPS) for cytokine release The following 8 solutions are mixed with blood from different persons and incu bated at 37 C: 1) 1 ml EDTA-blood (person X) + 30 41 Gc batch 11 15 2) 1 ml EDTA-blood (person X) + 30 pl Gc batch 13 3) 1 ml EDTA-blood (person Y) + 30 pl Gc batch 11 4) 1 ml EDTA-blood (person Y) + 30 g1 Gc batch 13 5) 1 ml EDTA-blood (person X) + 30 p1 PBS 6) 1 ml EDTA-blood (person Y) + 30 1 PBS 20 7) 1 ml EDTA-blood (person X) + 30 pl Gc batch 11 + 50 p1 LPS from Klebsiella pneumoniae (5 mg/ml) 8) 1 ml EDTA-blood (person X) + 50 pl LPS from Klebsiella pneumoniae (5 mg/ml) 9) 1 ml EDTA-blood (person Z) + 30 p1 diphtheria toxoid (5.78 mg/ml) 25 10) 1 ml EDTA-blood (person Z) + 30 pl tetanus toxoid (993 Lf/ml) 11) 1 ml EDTA-blood (person Z) + 30 p1 LPS from Klebsiella pneumoniae (5 mg/ml) 12) 1 ml EDTA-blood (person Z) + 30 p1 LPS from Salmonella typhimurium (5 mg/ml) 30 13) 1 ml EDTA-blood (person Z) + 30 pl milliQ water After 1 min (A), 2 h (B), 24 h (C) and 48 h(D) 180 pl of each of the 8 solutions are spotted on filter paper and allowed to dry. Samples are subsequently (after 14 days 12 WO 2008/064684 PCT/DK2007/000528 storage at -20 'C) analysed for content of cytokines using Luminex technology (22). The results are shown in Table 1. It can be seen from the table that LPS induces large increases in IL-1b, IL-6, IL-8, MIP-1a, MIP-1b, while smaller but statistically significant changes are seen for other analytes, Diphteria toxoid induces an in 5 crease in MIP-1b. Table 1. Test of Gc globulin, diphtheria toxoid, tetanus toxoid and lipopolysaccha ride (LPS) for cytokine release (see example 5 for details). All results are in pg/ml unless otherwise stated. 10 Ana- sIL-6ra IFN- MOP IL-lb IL-2 IL-4 IL-5 IL-6 IL-8 IL-10 IL-12 IL-17 IL-18 TNF-a TNF-b TGF-b lyte ng/ml g 1 1A 120 33 18 57 62 155 297 104 188 3674 1269,4 137 137 470 1795 828 1B 71 26 14 55 52 148 289 91 138 2985 970,3 96 105 427 1462 594 1C 111 31 24 48 35 7592 289 89 191 2357 695,2 36 85 519 1339 616 ID 101 17 20 60 42 5680 279 89 156 1444 620,4 75 88 355 1296 1007 2A 10 30 11 47 35 124 232 71 140 2818 900,9 39 69 503 1442 560 2B 47 21 18 49 44 210 232 80 163 2637 902,8 60 78 427 1296 700 2C 73 25 22 61 46 8471 258 93 161 2802 874,9 119 90 503 1391 937 2D 104 34 21 45 35 7588 262 78 115 1758 799,5 84 76 412 800 789 3A <3 9 6 20 4 25 45 12 101 1502 516,9 24 17 213 889 91 3B 45 12 8 35 36 50 258 73 147 1600 498,1 28 70 434 903 430 3C 38 17 7 30 18 1956 80 25 101 1050 395,5 11 48 293 597 282 3D 55 15 6 40 43 2882 129 53 135 732 402,8 39 72 149 737 458 4A 69 24 7 44 38 77 272 102 138 2308 769,9 107 115 358 1472 557 4B 38 16 13 39 29 69 120 17 117 2003 613,8 28 56 332 1569 255 4C 43 25 18 36 47 2456 117 64 182 1317 537,8 30 102 351 903 477 4D 8 7 16 37 17 3346 43 39 94 727 430,0 15 70 165 597 414 5A 32 21 16 19 20 84 80 60 133 2535 876,4 39 95 427 1616 490 5B 25 22 11 29 18 110 67 25 122 2581 870,3 46 65 383 1391 446 5C 1 4 12 26 <3 3695 23 <3 70 1874 636,0 <3 26 261 889 273 5D 69 19 21 43 16 6488 166 44 122 1543 735,2 25 74 204 1540 870 6A 20 15 7 25 22 94 155 69 133 1980 651,5 74 105 284 1401 479 6B 45 24 16 37 44 68 82 80 152 1980 600,3 60 86 289 1124 506 6C 30 8 8 36 20 3055 61 2 67 1058 411,7 29 48 104 889 417 6D <3 <3 <3 <3 <3 1781 <3 <3 <3 155 138,1 <3 <3 <6 <6 <50 7A <3 24 15 24 26 81 115 27 124 2213 802,3 11 38 332 1472 183 7B 1223 25 24 28 578 2982 84 78 165 2234 712,3 14 724 371 1172 446 7C 14429 20 23 36 14077 13606 204 115 244 2686 706,2 964 1399 418 1422 529 7D 9413 15 15 39 11048 15148 117 108 228 1567 540,9 468 1020 342 860 594 8A 901 23 15 28 40 237 103 29 152 2627 915,1 41 52 341 1597 450 8B 1584 19 19 40 789 3494 101 66 251 2380 820,7 80 997 518 1328 344 13 WO 2008/064684 PCT/DK2007/000528 8C 11466 18 26 33 12878 13903 345 119 320 1809 620,1 339 1512 468 1391 705 8D 7402 16 12 23 11902 14428 222 95 219 878 562,9 190 1471 268 753 438 9B 148 33 20 20 21 1785 46 12 88 1058 8334 <3 81 350 875 624 9C 138 28 23 31 17 10091 3 12 149 1272 724,8 1 95 316 652 894 10B 25 37 22 15 14 383 92 7 106 1042 820,7 4 44 303 931 357 10C 69 28 22 23 11 9921 39 <3 110 987 664,7 6 61 268 56 578 11B 2948 24 43 21 1697 58145 103 78 183 1456 442,1 68 1205 222 489 623 11C 16953 37 24 66 4215 757774 299 73 264 1070 374,1 73 983 274 91 528 12B 1665 26 19 46 1539 16428 25 28 148 1153 382,8 129 844 388 247 479 12C 12805 32 21 39 3715 541309 100 70 268 1450 339,3 80 750 274 680 907 13B 83 17 14 37 <3 252 7 51 70 1017 351,4 27 19 328 389 554 13C 60 29 17 21 <3 67105 2 44 74 1384 361,4 225 40 326 273 508 MMP-9 BDNF CRP RANTES int.st.dev Analyte MIP-la MIP-1b pg/mi TREM-1 ng/ml GM-CSF NT-4 pg/mi ng/ml .% 1A 286 1313 1,40 3509 16,2 63 85 0,68 188,0 32 1B 174 1285 1,19 3917 11,2 52 84 0,53 136,8 10 1C 221 1091 1,36 2609 14,2 62 43 0,43 158,3 -7 1D 210 549 1,05 2848 14,2 112 105 0,40 118,8 21 2A 254 1387 1,20 2848 11,9 65 90 0,49 153,0 -4 2B 192 1305 1,12 3001 11,6 88 57 0,53 116,7 7 2C 200 1055 1,33 2925 17,7 88 72 0,52 191,1 20 2D 219 677 1,16 3223 19,1 170 110 0,44 160,8 12 3A 73 852 1,15 2609 6,2 25 35 0,38 55,6 -8 3B 106 1067 1,15 2443 6,9 86 52 0,57 50,2 15 3C 154 627 1,26 2181 8,9 45 40 0,36 57,9 -5 3D 137 193 1,13 2690 8,9 82 47 0,38 51,7 13 4A 192 1124 1,59 3983 10,8 51 100 0,93 97,3 37 4B 112 996 1,51 2609 9,7 60 60 0,48 92,1 9 4C 201 716 1,37 2925 11,0 83 70 0,51 88,8 6 4D 96 199 1,32 1696 11,0 85 53 0,37 82,7 1 5A 192 1327 1,11 1358 11,0 41 43 0,48 127,2 -4 5B 167 1196 1,02 1800 10,9 22 57 0,44 119,8 -7 5C 88 940 1,03 2690 11,8 15 47 0,30 115,6 -6 5D 219 702 1,30 3001 17,4 76 85 0,37 176,5 3 6A 187 919 1,37 3223 9,5 68 74 0,63 84,2 18 6B 214 1087 1,31 3438 8,3 59 82 0,58 70,6 15 6C 118 495 1,19 2090 8,0 <6 42 0,36 59,9 4 6D <6 <6 0,72 <313 2,9 <6 <3 0,03 20,3 -53 7A 51 1097 0,97 1231 9,2 48 45 0,38 118,4 -41 7B 4706 21819 1,05 <313 10,4 100 55 0,34 129,4 -1 7C 15802 32037 1,05 3076 15,6 76 67 0,34 159,3 -1 7D 15112 29767 0,74 2443 12,6 114 74 0,31 116,9 -4 14 WO 2008/064684 PCT/DK2007/000528 8A 257 1349 1,09 3438 11,2 70 77 0,42 130,7 -3 8B 5333 24582 1,13 3368 11,8 91 105 0,42 112,4 10 8C 14303 31580 1,04 3296 10,9 100 63 0,36 144,6 2 8D 14937 28500 0,89 1476 13,4 106 30 0,28 106,3 -3 9B 591 6076 1,42 1996 22,8 59 35 0,60 161,3 -1 9C 643 5472 1,28 1476 26,2 83 55 0,55 141,6 -9 10B 96 1099 1,43 2090 20,0 82 53 0,60 154,9 -8 10C 141 950 1,26 1899 23,7 59 55 0,50 137,7 -6 11B 5992 22797 2,10 2920 30,1 14 51 1,08 240,6 10 11C 11035 26838 1,51 2087 32,8 15 63 0,83 183,0 2 12B 4055 19656 1,81 2920 18,8 -10 24 0,92 163,0 5 12C 8644 26995 1,45 3257 26,2 23 15 0,76 175,0 -9 13B 142 1351 1,50 2747 16,7 12 35 0,86 159,8 -10 13C 77 1087 1,67 2920 22,9 2 13 0,76 164,7 -2 Example 6. Test of diphtheria toxoid, tetanus toxoid, tuberculin PPD and BCG for cytokine release, 5 The following 6 solutions are mixed and incubated at 37 'C: 1) 1 ml EDTA-blood (person Y) + 30 1.d diphtheria toxoid (5,78 mg/ml) 2) 1 ml EDTA-blood (person Y) + 30 R1 tetanus toxoid (993 Lf/ml) 3) 1 ml EDTA-blood (person Y) + 30 !xl BCG (4-16 x 106 cfu/ml) 10 4) 1 ml EDTA-blood (person Y) + 30 1 tuberculin PPD (0.4 pg/ml) 5) 1 ml EDTA-blood (person Y) + 30 pl milliQ water 6) 1 ml EDTA-blood (person Y) + 30 p1 BCG vaccine solvent (control) After 1 min (A), 2 h (B), 4 h (C) 6 h (D ), and 24 h (E) 180 pl of each of the 6 solutions 15 are spotted on filter paper and allowed to dry, Samples are subsequently (after stor age at -20 C for 30 days) analysed for content of cytokines using Luminex technol ogy (22). The results are shown in Table 2. From the table it can be seen that BCG induces a large increase in IL-8 and MIP-1b compared with the control. Similarly, diphtheria toxoid, tetanus toxoid and PPD induces increases in IL-8 and MIP-1b, 20 while smaller but statistically significant changes are seen for other analytes. 15 WO 2008/064684 PCT/DK2007/000528 Table 2. Test of diphtheria toxoid, tetanus toxoid, tuberculin PPD and BCG for cyto kine release (see example 6 for details). All results are in pg/ml unless otherwise stated. analyte IL-1b IL-2 IL-4 IL-5 IL-6 IL-8 IL-10 IL-12 IL-17 IL-18 IA 47 42 9 11 161 99 477 160 73 2609 1B 54 76 11 14 130 284 394 201 69 3761 1C 90 146 27 8 115 588 637 226 87 2564 ID 97 124 26 22 217 783 706 267 111 3282 1E 106 153 17 20 135 7290 981 336 83 1745 2A 29 8 4 11 73 95 61 132 43 2233 2B 44 77 13 7 93 135 410 217 47 2202 2C 43 82 14 10 103 187 493 233 68 2726 2D 57 113 16 12 110 234 468 139 86 3265 2E 54 120 8 10 143 6335 811 185 63 1707 3A 33 26 26 33 75 113 240 213 78 2934 3B 77 93 14 2 97 268 268 158 56 2556 3C 160 155 11 18 127 998 533 252 54 2763 3D 145 <3 24 13 49 1439 378 76 54 3104 3E 113 92 3 10 67 27779 202 120 75 1597 4A 152 96 2 4 125 149 323 183 47 2461 4B 43 268 16 20 64 160 286 137 53 2512 4C 31 79 14 20 60 189 376 140 77 2567 4D 665 71 568 687 493 465 1812 746 1355 3170 4E 70 <3 8 13 81 7011 386 202 59 2432 5A 48 68 14 9 26 136 259 77 34 2660 5B 44 220 14 3 46 117 168 109 38 2461 5C 23 195 2 8 63 114 444 76 64 2221 5D 25 179 9 11 100 174 350 133 60 2982 5E 30 218 13 8 25 3558 417 146 79 1478 6A 27 121 16 10 46 126 461 154 51 2406 6B 32 95 10 3 34 128 400 149 41 2353 6C 19 101 13 24 9 131 256 91 71 2413 6D 50 102 7 22 70 163 281 183 51 2876 6E 27 97 10 11 87 5038 404 155 69 1474 5 analyte sIL-6ra ng/ml IFN-g TNF-a TNF-b MCP-I TGF-b 1A 1016,9 78 61 1392 2869 816 lB 1218,9 118 39 1474 2288 210 1C 822,0 209 109 1569 2126 556 1D 1091,7 165 150 1872 3048 791 1E 863,0 155 136 1724 2213 852 2A 857,1 72 158 1329 1600 276 2B 839,0 57 7 1865 1760 554 2C 955,2 52 90 1390 1794 515 16 WO 2008/064684 PCT/DK2007/000528 2D 1095,0 109 77 1599 2838 582 2E 835,5 91 34 1308 1990 551 3A 981,4 <3 69 1187 1506 671 3B 851,1 59 60 1291 2041 471 3C 985,7 153 59 1454 2543 405 3D 1045,6 67 48 1351 1500 542 3E 787,5 9 112 1183 1240 508 4A 941,4 71 60 1807 2800 623 4B 833,1 107 72 1310 1766 527 4C 937,6 165 112 1563 1211 384 4D 1186,3 93 247 2142 6253 113 4E 966,0 6 59 1012 1234 579 5A 885,7 5 35 1283 1473 305 5B 887,3 62 21 1593 2341 284 5C 735,4 229 65 1522 1262 520 5D 1042,6 154 129 1535 2441 426 5E 802,9 172 69 1602 107 256 6A 852,2 122 45 1674 1996 627 6B 758,5 41 97 1664 1189 372 6C 695,6 30 62 1492 884 378 6D 943,3 177 16 1516 736 473 6E 808,6 60 91 1305 1256 619

RAN

MMP-9 BDNF GM- CRP TES int,st,d analyte MIP-la MIP-1b pg/mi TREM-1 ng/mi CSF NT-4 pg/ml ng/ml ev,% 1A 85 1307 11,3 5676 8,0 21 23 0,46 56,2 6 1s 182 2534 15,6 6485 12,2 22 24 0,55 62,8 -1 IC 210 2883 14,1 6254 10,9 22 17 0,49 59,0 5 ID 224 3102 17,2 6562 13,0 26 33 0,57 71,8 9 1E 205 1053 14,3 5792 10,6 45 41 0,48 65,3 0 2A 75 1308 7,4 4821 7,1 19 16 0,38 50,0 -1 2B 116 1345 13,1 5599 8,3 24 13 0,41 55,1 3 2C 99 1163 17,7 5521 10,7 18 24 0,50 63,2 0 2D 70 1234 19,1 5521 10,7 25 20 0,53 59,3 1 2E 125 375 27,0 5985 11,4 41 23 0,45 56,9 0 3A 112 1189 12,0 7747 8,3 17 28 0,48 45,3 -4 3B 235 3717 8,1 5289 9,0 20 14 0,39 41,8 4 3C 410 7922 15,3 4860 9,2 20 26 0,45 41,5 2 3D 296 8706 10,8 7289 11,0 23 20 0,44 47,3 1 3E 281 6280 14,2 4232 12,3 33 17 0,38 42,5 -12 4A 128 1397 11,0 5715 9,1 20 20 0,47 39,6 4 4B 110 1159 10,7 5483 8,5 17 24 0,46 46,3 -1 4C 45 1122 10,0 3356 9,5 18 22 0,45 46,0 -4 17 WO 2008/064684 PCT/DK2007/000528 4D 866 1301 15,4 21919 12,4 36 447 0,44 43,3 -5 4E 64 183 19,6 5521 8,3 37 15 0,45 47,3 -11 5A 69 993 15,3 4938 9,4 19 16 0,46 44,6 -5 6B 4 1087 10,4 4743 8,9 19 15 0,39 43,2 2 5C 60 1248 8,1 5521 8,3 23 15 0,45 45,6 2 5D 41 1296 21,3 4035 12,5 28 20 0,52 50,5 3 6E 35 388 8,7 4272 10,7 42 5 0,40 46,1 -17 6A 57 1200 11,8 6331 8,2 19 13 0,45 49,1 1 6B 98 1117 13,5 7251 8,5 21 18 0,42 48,6 0 6C 85 1228 10,1 5016 7,5 22 33 0,40 46,4 -7 6D 66 1118 20,6 6101 9,6 27 24 0,47 49,5 4 6E 83 256 11,9 4469 10,7 39 14 0,39 50,8 -9 Example 7. Storage of samples for extended periods of time, 5 Dried blood spot samples (DBSS) should be stored dried and preferable at about -20' C. Room temperature can also be used as long as the samples are protected from moisture. In Denmark all residual DBSS have since 1982 been stored in a biological speci men bank at - 240 C, in accordance with regulations from the Ministry of Health 10 (23). For stability studies, DBSS stored for 23 years, 3 years and 1 month respec tively, were taken anonymously from the Danish DBSS specimen bank. The mean concentrations of each analyte from each period were calculated from 10 samples and compared to routinely collected anonymous DBSS that were stored in the laboratory for 2 weeks at -20C' (Table 3). It can be seen that within ex 15 perimental error, there is no deterioration of the samples even upon 23 years of storage. 18 WO 2008/064684 PCT/DK2007/000528 Table 3. Analysis of samples stored for short (1 month), long (3 years) and extended (23 years) periods of time, Results are expressed as per cent of concentration de tectable in 2 week old DBSS not yet put to storage in the PKU-biobank. Samples 5 were extracted and analyzed as described in examples 2-4, 23 years 3 years 1 month IL-1p 44 43 93 IL-2 116 115 113 IL-4 91 91 107 IL-5 105 116 122 IL-6 95 101 108 IL-8 28 38 64 IL-10 124 103 129 IL-12 95 108 107 IL-17 94 100 107 IL-18 138 113 129 TNF-a 92 101 109 TNF-P 88 94 93 IFN-y 117 119 121 RANTES 87 89 90 MCP-1 94 112 112 GM-CSF 102 107 108 MIP-1a 85 88 98 MIP-1p 59 76 79 sIL-6ra 48 101 113 TGF-p 111 100 95 MMP-9 57 49 93 TREM-1 68 84 129 CRP 73 123 110 BDNF 22 54 58 NT-4 54 63 111 19 WO 2008/064684 PCT/DK2007/000528 References 1. Beck WS (Ed.). Hematology. MIT Press 1985, 2. Bloom AL, Thomas, DP (Eds.). Haemostasis and thrombosis, Longman 1987. 5 3. Janeway CA, Travers P, Walport M, Capra JD. Immunobiology. Elsevier 1999. 4, Thadikkaran L, Siegenthaler MA, Crettaz D, Queloz PA, Schneider P, Tissot JD. Recent advances in blood-related proteomics. Proteomics. 2005;5:3019 34, 10 5. Anderson NL, Anderson NG. The human plasma proteome: history, charac ter, and diagnostic prospects. Mol Cell Proteomics. 2002;1:845-67. 6. Steinke JW, Borish L. Cytokines and chemokines. J Allergy Clin Immunol, 2006;117:S441-5. 7. Blach-Olszewska Z. Innate immunity: cells, receptors, and signaling path 15 ways. Arch Immunol Ther Exp. 2005;53:245-53. 8. Lapidot T, Petit I. Current understanding of stem cell mobilization: the roles of chemokines, proteolytic enzymes, adhesion molecules, cytokines, and stromal cells. Exp Hematol, 2002;30:973-81. 9. Cravens PD, Lipsky PE. Dendritic cells, chemokine receptors and autoim 20 mune inflammatory diseases. Immunol Cell Biol. 2002;80:497-505. 10. Villas BH. Flow cytometry: an overview. Cell Vis. 1998;5:56-61. 11, Stelzer GT, Robinson JP. Flow cytometric evaluation of leukocyte function. Diagn Clin Immunol. 1988;5:223-31. 12. Jerome KR, Sloan DD, Aubert M. Measurement of CTL-induced cytotoxicity: 25 the caspase 3 assay. Apoptosis. 2003;8:563-7. 13. Andersen MH, Schrama D, Straten TP, Becker JC. Cytotoxic T cells. J Invest Dermatol, 2006;126:32-41. 14. Troutt AB, Maraskovsky E, Rogers LA, Pech MH, Kelso A. Quantitative analysis of lymphokine expression in vivo and in vitro. Immunol Cell Biol. 30 1992;70:51-7, 15. Schmittel A, Keilholz U, Thiel E, Scheibenbogen C. Quantification of tumor specific T lymphocytes with the ELISPOT assay. J Immunother. 2000;23:289 95, 16. House RV. Theory and practice of cytokine assessment in immunotoxicology. 35 Methods. 1999;19:17-27. 20 WO 2008/064684 PCT/DK2007/000528 17. Meidenbauer N, Hoffmann TK, Donnenberg AD. Direct visualization of anti gen-specific T cells using peptide-MHC-class I tetrameric complexes. Methods. 2003;31:160-71, 18. Bousso P. Generation of MHC-peptide tetramers: a new opportunity for dis 5 secting T-cell immune responses. Microbes Infect. 2000;2:425-9. 19. Hogrefe WR. Biomarkers and assessment of vaccine responses. Biomarkers. 2005;10:S50-7. 20. Manz RA, Hauser AE, Hiepe F, Radbruch A. Maintenance of serum antibody levels. Annu Rev Immunol. 2005;23:367-86. 10 21, Mei JV, Alexander JR, Adam BW, Hannon WH. Use of filter paper for the collection and analysis of human whole blood specimens. J Nutr. 2001;131:1631S-6S. 22. Skogstrand K, Thorsen P, Norgaard-Pedersen B, Schendel DE, Sorensen LC, Hougaard DM. Simultaneous measurement of 25 inflammatory markers and 15 neurotrophins in neonatal dried blood spots by immunoassay with xMAP technology. Clin Chem. 2005;51:1854-66. 23. Norgaard-Pedersen B, Simonsen H. Biological specimen banks in neonatal screening. Acta Paediatr Suppl 1999;88:106-9. 20 21

Claims (9)

1. A diagnostic test and method comprising mixing blood or another biological fluid sample with a test compound and spotting the blood on filter paper for 5 subsequent analysis of the effect of the test compound on the blood.

2. A diagnostic test according to claim 1, where the biological fluid is a cerebro spinal fluid, a peritoneal fluid, a cyst fluid, an amniotic fluid, a lavage fluid, a saliva, a cell extract or a tissue extract. 10

3. A diagnostic test according to claim 1-2, where the test compound is chosen among an amino acid, a peptide, a protein, a carbohydrate, an oligosaccha ride, a polysaccharide, a glycoprotein, a lipid, a lipoprotein, a glycosami noglycan, a hormone, a steroid, a vitamin, a low molecular weight synthetic 15 compound which influences the blood to cause an alteration of its composi tion.

4. A diagnostic test according to claim 1-3, where the test compound is a toxin, allergen, autoantigen, bacterial protein or polysaccharide, viral protein, fun 20 gal protein or polysaccharide, parasitic protein or polysaccharide, bacterial lipopolysaccharide or any other compound relevant to diseases.

5. A diagnostic test according to claim 1-4, where the sample is analysed for the content of cytokines, chemokines and growth factors and/or neurotransmit 25 ters or other polypeptides and proteins.

6. A diagnostic test according to claim 1-5, where the sample is analysed for the content of clinical parameters such as CRP, IgG, IgA, IgM, IgD, IgE, specific (i.e. antigen specific) antibodies, transferrin, albumin and/or transthyretin. 30

7. A diagnostic test according to claim 1-6, where the effect of the test com pound is analysed by immunoassay, bioassay, mass spectrometry, HPLC, GC, GC-MS. 22 WO 2008/064684 PCT/DK2007/000528

8. A diagnostic test according to claim 7, where the preferable methods of analysis are ELISA assays, FLISA assays, DELFIA assays, Luminex assays, luminescence assays, electrochemiluminescence assays, scintillation prox imity assays, radioimmunoassays, MALDI-MS, ESI-MS and ambient-MS 5 (e.g.DESI-MS).

9. A method comprising mixing blood or another biological fluid sample with a test compound and spotting the blood on filter paper for storage, transport and/or handling before subsequent analysis of the effect of the test com 10 pound on the blood, biological fluid or sample. 23